For the past decade, the Division of Urology at VCU Health has provided comprehensive exposure to robotic surgery as part of our residency training program.

Major robotic surgical procedures are regularly performed at both VCU Health and the McGuire VA Medical Center with approximately 5-7 robotic cases per week by the VCU Urology team, totaling about 250 cases per year. Depending on the level of training, resident involvement ranges from bedside assistance to robotic console control. Dual console systems are available at both VCU (three systems) and VAMC (one system).

Becoming proficient in robotic surgery remains a key goal in the surgical education of our urology residents. According to the AUA guidance for robotic surgery standard operating procedure (SOP), a urologist completing a residency program should have logged a minimum of 20 robotic cases (either pediatric and/or adult), with console time for a key portion of the procedure with at least 10 cases. Moreover, the AUA recommends the implementation of a curriculum involving virtual reality simulator exercises. 

Proficiency is gained at different levels of training and depends on unique factors such as individual ability, motivation, and available learning resources. Although our graduating residents routinely gain proficiency in key steps of common urologic robotic procedures including robotic radical prostatectomy, radical nephrectomy, partial nephrectomy, a structured learning process will enhance this process and is the focus of this curriculum. 

A key part of the learning process is to gain experience with bedside assisting, which is widely recognized to be key component for a variety of reasons including: acquiring basic laparoscopic skills, understanding key steps and technical nuances of the procedure, gaining awareness of the interaction and dynamics between the assistant and the surgeon, and understanding patient positioning, docking and port placement strategies.  

Our robotics curriculum consists of:

Educational Components

  • Online learning
  • Faculty Lectures and Video Analysis
  • Simulation Training
  • Dry Lab Boot Camps
  • Cadaver Wet Lab Boot Camps
  • Bedside Assistance Training
  • Console Surgeon Modular Training

Assessment Tools

  • Certificates (for online modules)
  • Attendance logs (for bootcamps and lectures)
  • End of semester “robotic” evaluation done by Robotic faculty
  • SIMPL app for OR cases

 

PGY2 CURRICULUM:

Educational Objectives for PGY2:

PGY2 residents are expected to gain familiarity with the principles of laparoscopic and robotic surgery, achieved through online educational resources and attendance at structured educational events. Events will include lectures and video reviews by faculty and guest speakers. PGY2 residents will participate in “hands-on” bootcamps, cadaver wet labs, and encouraged to use the MIMIC simulator. PGY2 residents are expected to start beside assisting, supervised by a senior resident, surgical assistant, or attending.

Year-End Goals for PGY2:

  • Familiarity with main indications of robotic surgery in Urology
  • Familiarity with basic principles of laparoscopy and robotic-assisted laparoscopy
  • Knowledge and understanding of main laparoscopic and robotic instruments
  • Start building hands-on skills as bedside assistant

Check-list for Completion of PGY2 Requirements:

  • Complete Intuitive Surgical online “modules for residents/fellows” 
  • Complete daVinci System In-Service Training
  • Complete AUA University online module “Fundamentals of Robotic Surgery and Pediatric surgery” 
  • Attend all monthly robotic lectures and video analysis sessions – sessions will be recorded for post-review if residents cannot attend in-person
  • Attend a minimum of two robotic surgery bootcamps 
  • Attend one cadaver wet lab if available
  • Serve as bedside assistant for a significant portion or assistant with opening/closing of at least 10 robotics cases

Optional Additional Training:

  • Use the MIMIC simulator on your own time

 

PGY3 CURRICULUM:

Educational Objectives for PGY3:

The objective for the PGY3 year is to reinforce initial knowledge and skills in robotic surgery through the use of on-line educational resources and lectures/video reviews by faculty and guest speakers. Hands on training will be improved through participation in boot camps and one cadaver wet lab. PGY3 residents are strongly encouraged to use the MIMIC simulator and continue bedside assisting, mostly during the Pediatric rotation.

Year-End Goals for PGY3:

  • Familiarity with the main steps of the most common robotic urologic procedures
  • Reinforce hands-on skills as bedside assistant

Check-list for Completion of PGY3 Requirements:

  • Complete AUA University online modules: Transperitoneal prostate, Partial Nephrectomy, Pyeloplasty, Sacrocolpopexy, Radical cystectomy
  • Attend all monthly robotic lectures and video analysis sessions – sessions will be recorded for post-review if residents cannot attend in-person
  • Complete the “VCU Urology curriculum” on the da Vinci® Skills Simulator (dVSS) at VCU with a minimum required score of 80%
  • Attend a minimum of two robotic surgery bootcamps 
  • Attend one cadaver wet lab if available
  • Serve as bedside assistant for a significant portion of at least 15 robotics cases

Optional Additional Training:

  • Use the MIMIC simulator on your own time 

 

PGY4 CURRICULUM:

Educational Objectives for PGY4:

The objective for the PGY4 year is skill optimization and gaining experience as console surgeon. PGY4 residents will continue to use online educational resources as well lectures/video reviews by faculty (and guest speakers). In addition, involvement in hands on training will be increased through bootcamp and cadaver wet lab sessions. The PGY4 resident will increase involvement in beside assisting and begin training as console surgeon in a modular fashion for two index procedures (robotic radical prostatectomy and partial nephrectomy) as well as additional procedures.

Year-End Goals for PGY4:

  • Be familiar of the main steps of the most common robotic urologic procedures
  • Be aware of potential complications and methods of prevention
  • Optimize hands-on skills as bedside assistant
  • Start building hands-on skills as console surgeon

Check-list for Completion of PGY4 Requirements:

  • Complete Intuitive Surgical online “modules for surgeon”, 
  • Complete da Vinci System In-Service Training (Tashana/Yolanda/IS rep to assist)
  • Attend all monthly robotic lectures and video analysis sessions – sessions will be recorded for post-review if residents cannot attend in-person
  • Attend a minimum of two robotic surgery bootcamps
  • Attend one cadaver wet lab if available
  • Serve as bedside assistant or assistant with opening/closing at least 15 robotic cases 
  • Serve as console surgeon for portions of at least 10 robotic index cases

Optional Additional Training:

  • Use the MIMIC simulator on your own time 

 

PGY5 CURRICULUM:

Educational Objectives for PGY5:

The objective for the PGY5 year is development of proficiency as a console surgeon for all key steps of the two robotic index procedures as well as others. The PGY5 resident is expected to acquire critical knowledge for a range robotic techniques and nuances. To achieve proficiency, PGY5 residents will continue to use online educational resources, attend lectures/video reviews by faculty (and guest speakers), and participate in hands on training through bootcamps, cadaver wet lab sessions, and continued work as a bedside assistant. Most importantly, PGY5 residents will be involved as console surgeon in a modular fashion, under the direct supervision of the urology attending, and benefitting from the use of the dual console system. 

Year-End Goals for PGY5:

  • Be knowledgeable about the critical steps of each robotic procedure
  • Be able to independently perform, under direct supervision, all main steps of two index robotic procedures and other common procedures.
  • Be comfortable managing complex cases and anatomical variations

Check-list for Completion of PGY5 Requirements:

  • Attend all monthly robotic lectures and video analysis sessions – sessions will be recorded for post-review if residents cannot attend in-person
  • Attend a minimum of two robotic surgery bootcamps
  • Attend one cadaver wet lab if available
  • Serve as bedside assistant when required
  • Serve as console surgeon for significant portions of at least 50 robotic cases 

Optional Additional Training:

  • Use the MIMIC simulator on your own time